Post 4 of 4 – Rx for Pain – The Obama Healthcare Plan

I was going to list Mr. Obama’s proposals one by one and then discuss what is right and what is wrong with each.  I have decided that it would take me too long and no sane person would read it all.  So, instead I will present a brief list of things I question about Mr. Obama’s plan, a list of the areas where I think Mr. Obama is on the right track, and my list of things I think we should consider to improve our healthcare delivery system.

Where Mr. Obama has it WRONG:

First and foremost, I disagree with the basic premise of the OBAMA PLAN that Healthcare is a basic right.  Mr. Obama’s entire argument for Universal Healthcare is based on this assumption.  Mr. Obama claims that since healthcare is a right, it should be provided for all people.  In his view, the way to do this is to place the burden for providing healthcare on a government agency funded by taxpayer dollars.  His assumption is wrong.  Healthcare is not a basic human right.   Is it a basic right to have three meals a day and shelter over your head?  Is it a basic right to have clothing?  Is it a basic right to have a job?  How about a television? Ensuring that all citizens are healthy is a lofty and well meaning goal.  Asking you, no, requiring you, to pay for treatment for your neighbor who drinks a quart of gin and smokes three packs a day is not the way to achieve that goal.  Second, placing all healthcare in the hands of a government agency will only guarantee mediocre care or worse.  Just look at what sick Canadians do.  They come across the border to get good care here if they can afford it.

Where Mr. Obama has it RIGHT:

An ounce of PREVENTION is worth a pound of cure.  Mr. Obama is right when he says that we need to spend more money and effort in preventing ill health.  He is also right to emphasize using current technology to manage healthcare records.  And, I think he is on the right track to suggest that health insurance should be portable, allowed to move with the person regardless of where he or she works.  None of these recommendations requires universal healthcare or a government managed system to be implemented.

Here is the list of Healthcare issues and my take on each:

1. Cost – 

I agree that healthcare costs have risen more than they should, effectively pricing many companies and individuals out of the market.  Some of this is due to Medicare and Medicaid paying below market prices for services therefore pushing the costs to the private sector to pay.  Some is caused by providing emergency room care for those who are not covered by insurance plans.  Some is caused by an adversarial relationship between providers of worker’s compensation and regular health insurance.  This drives up legal and administrative costs.  Part is due to a legal system that has no limit on its rewards for successful lawsuits and the pressure that puts on Physicians and Hospital liability insurance costs.  Some is due to Hospitals keeping up with the competition by buying all the latest technology.  Much is due to a less healthy population.  We are fatter, more sedentary.  The list goes on but none of the reasons suggest Universal Healthcare as the solution.

We would go a long way toward controlling costs if we would do the following things:  1.  Emphasize prevention.  If insurance companies were allowed to sell health insurance based on the health of the individual (like they sell life insurance based on the expected life of the individual), there would be incentives to remain healthy.  Businesses could buy better coverage or at lower prices if they could show that they have healthy populations.  2. If we had 24 hour care supplement insurance to replace Worker’s Compensation insurance, the same company would cover an employee whether his lung disease was the result of smoking or his work environment.  In the current situation, the worker’s comp company fights with the regular health insurance company to see who pays and how much.  Legal costs, alone, add dramatically to the cost of his treatment.   3.  Pass a cap on awards, especially “pain and suffering” awards for medical malpractice lawsuits.  

2. Healthcare Delivery – Do the economies of scale offered by a huge government health system offset the one-size-fits-all care and impersonal treatment that normally result from putting care in the hands of a large organization like the federal government?  My belief is that working within a government health system would more resemble working with the IRS than working with a local clinic or hospital.  Kaiser Permanente is a huge HMO.  It has done a great number of things that are very positive and usually ranks near the top in cost containment, customer satisfaction, and prevention.  Even though it is a good example of how a huge organization can give (generally) good care, I seriously doubt that a federal government delivery system could do what Kaiser has done.  And, though Kaiser is near the top in customer satisfaction, that still doesn’t come close to the satisfaction levels of patients of small local clinics.  Most consumers don’t like working with the IRS and will want nothing to do with a federal government controlled healthcare delivery system.

3.  Prescription Costs – I believe that the U.S. and Switzerland are the only two countries that pay full price for prescription drugs, but,  that is only part of the reason drugs are so expensive.  The cost to bring a new drug to market are driven by FDA requirements that exceed those of almost every other country.  We need to look to see if this system can be improved.   We tend to believe there is a silver bullet out there for every problem.  It is easier to prescribe a pill than to change behavior.  Doctors are trained to ‘fix’ things with drugs.  We need to look carefully at this paradigm.   Many drugs are badly overprescribed. This greatly increases medical costs in general.   It has been argued that much of what is prescribed for the aged and most prescriptions of ridilin are used to control patients behavior to make it easier to care for them.  

4.  Legal Costs – I think that our legal system drives costs for care higher than they would be if limits were placed on awards in most malpractice litigation.  I also believe that the adversarial relationship between the Worker’s Comp and Health Insurance companies drives legal, and therefore medical insurance, cost upward significantly.

5.  Prevention – The key (and one of the few) success of many of the nationalized healthcare programs in Europe is the emphasis on prevention.  The only true way to lower medical costs is to require fewer medical interventions.  Prevention is the path to this goal.  There are lots of ways to approach this, worthy of at least another post, but I like the annual risk assessment and health screening used by Kaiser Permanente better than any other ideas I have seen.

6.  Portability – I think that a good argument could be made for encouraging both insurance companies and employers to provide portability to the insurance plans they offer.

7.  Insurance – I like Mr. Obama’s idea of an insurance plan for catastrophic care.  All basic insurance could be reduced in cost dramatically if the cost of catastrophic care could be insured outside of the regular plan.  How this would be done in a cost effective way, I am not sure, but would like to hear ideas.

8.  Stem cell Research/Cloning/Abortion/Euthanasia/Assisted Suicide – Each of these items becomes a hot potato issue and can derail honest discussion of the basic healthcare delivery issue.  I think that these fall mostly in the area of personal decisions.  Handling these things at the State level and even the local level sounds like a better solution to me.

9.  Bonus Issue – Is healthcare a right or a privilege?  As I said above, I think the major flaw in Mr. Obama’s plan is that it is based on the false premise that Healthcare is a right.  When I am in a cynical mood, I think the only justification for calling healthcare a right is to bring the power (that comes with controlling the healthcare of the people) to the Central Government.

I think it is important that we have a national discussion of healthcare delivery.  Though far from perfect, I think it would be very instructive to look at the history and practices of Kaiser Permanente.  Their success is based on three key practices which I think we would be well served to consider:  Pay Doctors who are part of an HMO a Salary thus removing incentives to perform unnecessary procedures; carefully manage hospital stays and move patients to less expensive clinics or home for much of the recovery period; and most important, in my mind, is their emphasis on prevention – annual health assessments.

I would appreciate your thoughts on any and all of this.

Here are links to the Intro, the first, second, and 3rd posts on this subject.

Post 2 of 4 – Rx for Pain – The Obama Healthcare Plan

This is post 2 of 4 on Healthcare.  See the intro to this discussion here and the first of the four posts here.

This post will attempt to describe the Obama Healthcare Plan.  Most of what you read here will be taken from the Obama/Biden Healthcare Plan as described on barackobama.com   It is broken down into the following areas to which I have attached brief summaries from Mr. Obama’s plan.

LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM WORK FOR PEOPLE AND BUSINESSES – NOT JUST INSURANCE COMPANIES – “The key is to provide information, incentives and support to help physicians and others work together to improve quality of care while reducing costs.”  “The Obama-Biden plan will improve efficiency and lower costs in the health care system by: (1) adopting state-of-the-art health information technology systems; (2) ensuring that patients receive and providers deliver the best possible care, including prevention and chronic disease management services; (3) reforming our market structure to increase competition; and offering federal reinsurance to employers to help ensure that unexpected or catastrophic illnesses do not make health insurance unaffordable or out of reach for businesses and their employees.”

AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL – “Barack Obama and Joe Biden will guarantee affordable, accessible health care coverage for all Americans.”  “The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.”

PROMOTING PREVENTION & STRENGTHENING PUBLIC HEALTH – “Barack Obama and Joe Biden believe that protecting and promoting health and wellness in this nation is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce, and federal and state and local governments. All parties must do their part, as well as collaborate with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt healthy lifestyles.”

On the surface, Mr. Obama’s plan addresses many of the 8 issues I posed in the Intro to this discussion.  I have highlighted below those areas that I think Mr. Obama’s plan addresses.  Those are:

1. Cost – Is the price of adequate healthcare too high? 

2. Healthcare Delivery – Is their a better way to distribute/deliver healthcare?

3.  Prescription Costs – Why are pharmaceuticals priced so much lower in almost every country outside of the USA?

4.  Legal Costs – Do malpractice lawsuits and the protection against lawsuits help or hinder the system?

5.  Prevention – Does our healthcare delivery model neglect prevention as a tool for national health care?  

6.  Portability – Does a system make sense that would allow a person to retain his or her healthcare coverage inspite of where he or she might work?

7.  Insurance – What part should be played by Insurance Companies in Healthcare delivery?  I appears that the Obama Plan gives a new insurance role to government.

8.  Stem cell Research/Cloning/Abortion/Euthanasia/Assisted Suicide – Should there be national policy on these issues?  This may be a mute point as it appears that he may avoid legislation on many of these items and just decree what he wants done as he did on Stem-cell research.

9.  Bonus Issue – Is healthcare a right or a privilege?  It appears that the Obama Plan assumes that Healthcare is a right.  

If I have missed a key element of the healthcare debate, please feel free to bring it to my attention.

The next post will discuss my opinions as to how Mr. Obama’s Plan will address each of the issues and will attempt to list the pros and cons of the Plan.  The final post will be all opinion (not just somewhat opinionated like the other parts of this post).  It will be my assessment of what would and would not happen under Mr. Obama’s Healthcare Plan.

Post 1 of 4 – Rx for Pain – The Obama Healthcare Plan

Below is a brief summary of each of the main issues in the Healthcare Debate.  I have tried to make this as apolitical as I can but I am not devoid of bias which may slip in from time to time.  If you haven’t read the intro to this series of four posts, please see it here.  If I have missed any of the key issues, please comment to that effect.

1. Cost – Is the price of adequate healthcare too high?  Does the cost drive people from the system and make them rely on emergency health care only?

2. Healthcare Delivery – Is the delivery system flawed?  Does a market system of allocation actually exist as it pertains to healthcare delivery?  Or is allocation of services set by current government controls and/or economic realities?  Do HMOs work or is there a better method of allocating healthcare?

3.  Prescription Costs – Why are pharmaceuticals priced so much lower in almost every country outside of the USA?

4.  Legal Costs – Do malpractice lawsuits and the protection against lawsuits increase the cost of our care out of proportion to the benefit provided by the legal remedies we now have?  Should we have caps on awards for medical malpractice?

5.  Prevention – Does our healthcare delivery model neglect prevention as a tool for national health care?  

6.  Portability – Does a system make sense that would allow a person to retain his or her healthcare coverage inspite of where he or she might work?

7.  Insurance – What part should be played in Medical Care by insurance companies?

8.  Stem cell Research/Cloning/Abortion/Euthanasia/Assisted Suicide – Should there be national policy on “reproductive rights” or “assisted suicide” or “cloning humans,” etc.?   Or, are these purely ethical issues that should be moved away from government action/interference?  Are they better considered at the State or local level?

9.  Bonus Issue – Is healthcare a right or a privilege?  Should it be given to all or earned?

Rx for Pain – The Obama Healthcare Plan – Intro

From the title above, it sounds like I am prejudging President Obama.  In fact, I think I am judging based on what he has said/written.  I have read all that was posted on the subject on his Campaign Website (www.barackobama.com) and many blogs and posts on both sides of the aisle.  I have been following his public statements.   What emerges from Mr. Obama’s election campaign and his first two months in office is a “plan” that hits all the main points of the debate and gives lip service to the problems.  It promises reform, cuts, and efficiencies, but few and vague details.  For example, he claims the average family will see its health insurance “costs will go down by as much as $2,500 per year.”  He implies that your healthcare cost will go down.  But, what he says is that your health insurance cost will go down.  He mentions only improved technology, competition, better prevention techniques, etc.  He mentions nothing of increased deductibles, or cost shifts to the government.  In short, he has left enough wiggle room to drive a hospital through it.

It is my intent to do 4 posts (after this intro) on Mr. Obama’s Healthcare Plan.  This first post will list and briefly discuss the chief issues currently being discussed regarding the US Healthcare Delivery System as it exists today.  The second will discuss the substance of the Obama Healthcare Plan.  The third will look at the pros and cons of what Mr. Obama offers.  Last will be my opinions as to what needs to be done and how it resembles/differs from the Obama Plan.

The Basic Issue: The Healthcare Industry now accounts for approximately 17% of our Gross Domestic Product, or an annual cost of about $2.5 Trillion.  That works out to more than $8,000 per man, woman, and child in the United States.  Yet, with all this money allocated to our health, it is estimated that between 45,000,000 and 50,000,000 people lack formal health insurance coverage.  In spite of amazing new drugs, new procedures, and new medical equipment, our National Health does not seem to be getting any better.  Most agree that the delivery of health care is uneven and could be improved.  Many people have little access to quality health care.  Employers can’t continue to pay for family healthcare for their employees and are shifting costs to the employees.  

The Specific Issues:

1. Cost – Is the price of adequate healthcare too high?  Does the cost drive people from the system and make them rely on emergency health care only?

2. Healthcare Delivery – Is the delivery system flawed?  Does the market system of allocation actually exist as it pertains to healthcare delivery?  Or is allocation of services set by current government controls and/or economic realities?  Do HMOs work or is there a better method of allocating healthcare?

3.  Prescription Costs – Why are pharmaceuticals priced so much lower in almost every country outside of the USA?

4.  Legal Costs – Do malpractice lawsuits and the protection against lawsuits increase the cost of our care out of proportion to the benefit provided by the legal remedies we now have?

5.  Prevention – Does our healthcare delivery model neglect prevention as a tool for national health care?

6.  Portability – Does a system make sense that would allow a person to retain his or her healthcare coverage inspite of where he or she might work?

7.  Insurance – What part should be played in Medical Care by insurance companies?

8.  Stem cell Research/Cloning/Abortion/Euthanasia/Assisted Suicide – Should there be national policy on “reproductive rights” or “assisted suicide” or “cloning humans,” etc.?   Or, are these purely ethical issues that should be moved away from government action/interference?  Are they better considered at the State or local level?

Beware.  This is one subject about which I will pose more questions than I will try to answer.  Your participation will be most helpful in making this worthwhile.  If, for example, I have missed a major issue and a commenter recommends it, I will try to add it to the debate.